Gabapentinoid use disorder. Update for clinicians

Gabapentinoids (gabapentin and pregabalin) are versatile drugs, indicated mainly for epilepsy and neuropathic pain, and have long been viewed as agents with little potential for abuse. Burgeoning prescribing patterns and studies indicate that these drugs are increasingly being abused, particularly by polydrug abusers who also abuse opioids. Gabapentinoid abuse is found in less 2% of the general population but may be as high as 15% to 22% among opioid abusers. Other risk factors for gabapentinoid abuse are less clear-cut but include mental health disorders. Gabapentinoids are relatively easy for drug abusers to obtain and many clinicians are not fully aware of their abuse potential. It is thought that gabapentinoids may offer psychoactive effects or enhance the effects of other drugs of abuse. Those who discontinue gabapentinoids abruptly may suffer withdrawal symptoms, but gabapentinoid overdose fatality is rare. Since gabapentinoids are often prescribed off-label to treat psychiatric disorders, these drugs may be dispensed to a particularly vulnerable population. Clinicians must be aware of the potential for Gabapentinoid Use Disorder: Update for Clinicians

Prevalence of insomnia symptoms and their associated factors in patients treated in outpatient clinics of four general hospitals in Guangzhou, China

Background: Data on the prevalence of insomnia symptoms in medical outpatient clinics in China are lacking. This study examined the prevalence of insomnia symptoms and their socio-demographic correlates in patients treated at medical outpatient clinics affiliated with four general hospitals in Guangzhou, a large metropolis in southern China. Method: A total of 4399 patients were consecutively invited to participate in the study. Data on insomnia and its socio-demographic correlates were collected with standardized questionnaires. Results: The prevalence of any type of insomnia symptoms was 22.1% (95% confidence interval (CI): 20.9–23.3%); the prevalence of difficulty initiating sleep was 14.3%, difficulty maintaining sleep was 16.2%, and early morning awakening was 12.4%. Only 17.5% of the patients suffering from insomnia received sleeping pills. Multiple logistic regression analysis revealed that male gender, education level, rural residence, and being unemployed or retired were negatively associated with insomnia symptoms, while lacking health insurance, older age and more severe depressive symptoms were positively associated with insomnia symptoms. Conclusions: Insomnia symptoms are common in patients attending medical outpatient clinics in Guangzhou. Increasing awareness of sleep hygiene measures, regular screening and psychosocial and pharmacological interventions for insomnia are needed in China. Trial registration: ChiCTR-INR-16008066. Registered 8 March 2016

The Sleep Condition Indicator: a clinical screening tool to evaluate insomnia disorder

Objective: Describe the development and psychometric validation of a brief scale (the Sleep Condition Indicator (SCI)) to evaluate insomnia disorder in everyday clinical practice.<p></p> Design: The SCI was evaluated across five study samples. Content validity, internal consistency and concurrent validity were investigated.<p></p> Participants: 30 941 individuals (71% female) completed the SCI along with other descriptive demographic and clinical information.<p></p> Setting: Data acquired on dedicated websites.<p></p> Results: The eight-item SCI (concerns about getting to sleep, remaining asleep, sleep quality, daytime personal functioning, daytime performance, duration of sleep problem, nights per week having a sleep problem and extent troubled by poor sleep) had robust internal consistency (α≥0.86) and showed convergent validity with the Pittsburgh Sleep Quality Index and Insomnia Severity Index. A two-item short-form (SCI-02: nights per week having a sleep problem, extent troubled by poor sleep), derived using linear regression modelling, correlated strongly with the SCI total score (r=0.90).<p></p> Conclusions: The SCI has potential as a clinical screening tool for appraising insomnia symptoms against Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria.<p></p&gt

Chronic insomnia : recent advances and innovations in treatment development and dissemination

Insomnia is a prevalent public health problem that carries an important psychosocial and economic burden for those affected, their families, employers, and for society at large. Despite its negative impacts, insomnia often remains untreated and, when treatment is initiated, it is predominantly with medication, an option that is not always acceptable to people with insomnia. There is extensive evidence that psychological approaches, primarily cognitive behavioural therapy, are effective, produce durable and generalizable outcomes, and should be the first line therapy for chronic insomnia. Nonetheless, these approaches remain under utilised in clinical (medical) practise. Several innovative and cost-effective treatment delivery models (e.g., telephone consultations, Internet-based treatment) have yielded promising results but despite these advances, there remains a problem of supply. A significant challenge for the future will be to disseminate more efficiently validated therapies and practise guidelines and increase their use in clinical practise. Additional training opportunities are also needed for psychologists to develop expertise in a new emerging behavioural sleep medicine subspecialty. (PsycINFO Database Record (c) 2016 APA, all rights reserved

Insomnia and psychosocial stress in patients with pain in the orofacial region

Tese de mestrado, Neurociências, Universidade de Lisboa, Faculdade de Medicina, 2020Insomnia, the most common sleep disorder, is highly prevalent and causes clinically significant functional distress or impairment, both at physical and psychological levels. Sleep complaints are present in a large majority of pain disorders and individuals with insomnia often suffer from pain. Pain in the orofacial region (OFR) includes the pain arising from the regions above the neck, in front of the ears, and below the orbitomeatal line, the oral cavity itself, and might be also associated with temporomandibular disorders. Few studies have been evaluating the relationship between OFR and insomnia but failed to address the triad OFR, insomnia, and associated psychosocial factors which was the purpose of the present study. For that, anonymized data of 184 adult patients with OFR, both sexes (71.2% women), aged 45.8±16.4 years were extracted from the self-screening WISE platform (Web-based Interdisciplinary Symptom Evaluation). Significant medical or psychiatric conditions, shift working, or drug treatments that may cause insomnia were exclusion criteria. Prevalence data for insomnia (ISI), stratified by severity grade, and psychometric measures (DCQ, GAD-7, IPQ, PCS, PHQ-4, PHQ-9, IEQ, and PHQstr) assessing the dysmorphic concern, anxiety, illness perception, pain related catastrophizing and disability, distress, depression, injustice experience, and psychosocial stress were performed. The correlations of psychometric scores with insomnia grades having gender, age, and employment status as putative confounders were analysed. Globally, patients had a normal weight or were pre-obese, being most of them light smokers and active workers. From the recruited patients, 34.8% reported insomnia symptoms, with 16.3% of them reaching moderate to severe insomnia which is clinically relevant. Pain intensities, psychosocial burden, and sleep disturbances were higher in women than men. Severe depression, anxiety, and distress were the most frequent symptoms (18.5-23.9%), while clinically relevant stress and dysmorphic concern were the least (5.40% and 3.80%, respectively). The results of correlation analysis of the psychometric measures and insomnia scores were as follows: DCQ, GAD-7, IPQ, PCS, PHQ-4, and PHQ-9 had moderate and strong associations (rs > 0.300) with ISI scores of all respondents and women (unlike the male group). The IEQ scores were strongly correlated with ISI scores between 8 and 21 (-0.608 70 years) had none. The active workers constitute the employment status with the highest number of associations between sleep problems and impaired well-being (anxiety, pain catastrophizing, distress, and depression), followed by the retired ones. Despite the small number of data, that should be increased in the future, we may conclude that insomnia and psychosocial stressors biunivocal influence each other, with different weights, in OFR patients. Due to the high incidence of clinically relevant insomnia in OFR patients, these patients should always be screened for insomnia, at least, with a self-assessed questionnaire and appropriately counselled. In addition, our study shows how an easy-to-use self-assessment instrument, when used judiciously by the patient, can be useful in clinical practice by promoting a more complete assessment of the patient, his personalized treatment, and the strengthening of the doctor-patient relationship.A insónia, o distúrbio do sono mais comum, é altamente prevalente e causa um sofrimento ou défice funcional clinicamente significativo, tanto a nível físico quanto psicológico. As queixas de sono estão presentes na grande maioria das patologias que cursam com dor e os indivíduos com insónia, em muitas circunstâncias, também têm dor. A dor na região orofacial (DROF) pode ser definida como uma dor localizada na região acima do pescoço, junto ao pavilhão auricular e abaixo da linha orbitomeatal, bem como na cavidade oral ou associada à patologia temporomandibular. Muitas doenças podem levar a síndromes de dor orofacial que atualmente são classificadas em vários subgrupos. Frequentemente, tratamentos cirúrgicos inadequados levam a um ciclo vicioso que cria uma situação de dor persistente, portanto, uma abordagem de tratamento multimodal é essencial para evitar o agravamento da dor de forma a que se não torne crónica. No entanto, atualmente, o controlo da dor orofacial permanece desafiante. De acordo com a International Headache Society existe uma diferenciação entre síndromes de dor na região orofacial e outras condições dolorosas. Alguns estudos já avaliaram a relação entre dor na região orofacial e insónia, mas ainda não abordaram a tríade dor na região orofacial, insónia e fatores psicossociais associados. Este foi o objetivo do presente estudo. Para isso, dados previamente anonimizados de 184 doentes adultos com DROF, de ambos os sexos (71.2% mulheres), com idade de 45.8 ± 16.4 anos, foram extraídos da plataforma de autoavaliação de sintomas WISE. Condições médicas ou psiquiátricas, trabalho por turnos ou tratamentos com fármacos que possam causar insónia constituíram os critérios de exclusão. Foram realizados estudos de prevalência de insónia (ISI) estratificada por grau de gravidade, bem como estudos de avaliação psicométrica (DCQ, GAD-7, IPQ, PCS, PHQ-4, PHQ-9, IEQ e PHQstr), analisando a preocupação dismórfica, ansiedade, perceção da doença, catastrofização e incapacidade relacionadas com a dor, angústia, depressão, experiência de injustiça e stress psicossocial. A correlação dos resultados psicométricos com os graus de insónia, considerando como fatores confundidores o sexo, idade e empregabilidade foi, também, efetuada. Globalmente, os doentes apresentavam peso normal ou eram pré-obesos, sendo a maioria fumadores leves e trabalhadores ativos. Dos doentes recrutados, 34.8% deles relataram sintomas de insónia e 16.3% apresentavam insónia moderada e grave, que são os dois tipos de insónia clinicamente relevantes. A intensidade da dor, a carga psicossocial e os distúrbios do sono foram superiores nas mulheres. Depressão, ansiedade e angústia severas foram os sintomas mais frequentes (18.5-23.9%), enquanto o stress e a preocupação dismórfica clinicamente relevantes foram os menos frequentes (5.40% e 3.80%, respetivamente). A correlação das medidas psicométricas com os estádios de insónia foram os seguintes: DCQ, GAD-7, IPQ, PCS, PHQ-4 e PHQ-9 tiveram associações moderadas e fortes (rs > 0.300) com os valores obtidos pelo ISI para todos as doentes, mas não para o grupo de doentes masculinos. Os valores do IEQ foram fortemente correlacionados com os valores do ISI entre 8 e 21 (-0.608 < rs < 0.626). A associação entre os valores do PHQstr e do ISI foi encontrada apenas em doentes com incapacidade para o trabalho. Doentes com idade compreendida entre os 30 e 39 anos apresentaram o maior número de correlações estatisticamente significativas entre as variáveis, ao contrário dos doentes com mais 70 anos para os quais não se encontrou nenhuma. Os trabalhadores ativos constituíram o estatuto profissional com o maior número de associações entre problemas de sono e alterações de bem-estar como ansiedade, catastrofização da dor, angústia e depressão, sendo seguidos pelos doentes reformados. Assim, em doentes com dor orofacial, a insónia e fatores de stress psicossocial influenciam-se mutuamente de forma biunívoca embora com pesos diferentes. Em conclusão, este trabalho, apesar de baseado numa pequena coorte de pacientes que deverá ser futuramente aumentada, enfatiza a interconexão entre DROF, insónia e carga psicológica, bem como a relevância de avaliar, em ambientes clínicos, comorbidades somáticas e psicológicas que podem interromper o sono. As mulheres, os trabalhadores ativos e os doentes jovens e de meia-idade tiveram um predomínio de resultados mais expressivos, ou seja, as pontuações do ISI correlacionaram-se mais fortemente com as medidas do eixo II, representando os grupos que devem ser acompanhados de perto. Para além disso, o nosso estudo demonstra como um instrumento de autoavaliação de fácil utilização, quando usado de forma criteriosa pelo doente, pode ser útil na prática clínica, promovendo uma avaliação mais completa do doente, bem como o seu tratamento personalizado e o fortalecimento da relação médico-doente

Prevalence And Health Burden Of Cardiovascular Disease In Older U.s. Veterans: Results From The 2019-2020 National Health And Resilience In Veterans Study

Importance. Cardiovascular disease (CVD) is one of the leading causes of death in the U.S. and is associated with a range of demographic, military, trauma, and clinical characteristics and physical and mental health conditions. Older military veterans may have an increased risk for CVD, given their advanced age and military experiences. However, the prevalence and health burden of CVD in population-based samples has not been well characterized. Objective. To characterize the current prevalence of CVD, and its association with sociodemographic, military, trauma, and clinical variables in a large, contemporary, and nationally representative sample of older U.S. veterans. Design. Cross-sectional study of 3,001 older U.S. military veterans (age 60 and older) using data from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS). Main Outcomes. Veterans were classified according to lifetime CVD status (CVD or no CVD [health care professional diagnoses of heart disease, heart attack, and/or stroke]). To determine the association of CVD with health status, a comprehensive range of mental and physical health variables were assessed using validated self-report assessments. Results. 25.5% of veterans reported having been diagnosed with CVD. Greater age, cumulative trauma burden, nicotine use disorder, and diagnoses of hypertension, high cholesterol, and diabetes were associated with CVD. CVD was independently associated with a range of mental (odds ratios [ORs]= 1.53-2.27) and physical (ORs=1.53-3.43) health conditions. Conclusions and Relevance. 1 in 4 older U.S. veterans reported having been diagnosed with CVD in their lifetimes. CVD was independently associated with a broad range of demographic, clinical, physical, and mental health variables in U.S. veterans, suggesting that CVD is linked to multiple health outcomes. Results highlighted the importance of CVD for prevention and intervention efforts in the older U.S. veteran population

Benzodiazepine Use and Dependence in Relation to Chronic Pain Intensity and Pain Catastrophizing

Benzodiazepines (BZDs), a class of sedative-hypnotic drugs, are at the center of an emerging prescription drug crisis. From approximately 1995-2015, overdose deaths involving BZDs quadrupled and average dose equivalents more than tripled. Specific concern has centered on elevated rates of BZD use among individuals with chronic pain, given that BZDs are generally not indicated for pain management. Consistent with negative reinforcement and motivational models of substance use, desire for pain alleviation may be a salient motivator of BZD use, particularly as individuals commonly report using BZDs for negative affect alleviation. The present study tested cross-sectional associations between pain intensity and clinically relevant BZD use patterns among individuals with chronic pain. We also examined the role of pain catastrophizing, a malleable transdiagnostic factor reflecting negative cognitive-affective pain responses. Participants were 306 adults (Mage = 38.7, 38.9% female) with chronic musculoskeletal pain and a current BZD prescription who completed an online survey study via Amazon Mechanical Turk. Hierarchical linear regression results indicated that pain intensity was positively associated with past-month BZD use frequency and BZD dependence severity. Logistic regression results indicated that greater pain intensity was associated with a 1.2 times greater likelihood of endorsing BZD misuse behaviors. Pain catastrophizing was positively associated with BZD dependence severity and likelihood of BZD misuse, after accounting for pain intensity. Initial findings implicate pain/pain-related cognitive-affective processes in higher-risk BZD use, and suggest pain relief is a common, yet underrecognized, self-reported motivation for taking BZDs. Future research should examine mechanisms underlying pain-BZD covariation and co-use behaviors

The Effect of Melatonin Upon Post-Acute Withdrawal Among Males in a Residential Treatment Program (M-Paws): A Randomized, Double-Blind, Placebo Controlled Trial

The study goal was to assess melatonin as an adjuvant treatment along with current pharmaco- and behavioral therapy for 28 days on weekly self-reported severity of anxiety, depression, stress, and sleep complaints as well as how sleep is affecting daily life in a sample of males in recovery from chemical dependency at a single, residential treatment site, Salvation Army Harbor Light Center in Pittsburgh, PA. This study was a single-center, randomized, double-blind, placebo-controlled, parallel group trial of 28 days. Participants were randomized to melatonin (5 mg) or placebo and instructed to administer the intervention nightly at bedtime. Primary self-reported outcome measures of severity of anxiety, depression, stress, as well as sleep complaints and how sleep is affecting daily life were assessed on a weekly basis with the Generalized Anxiety Disorder Scale (GAD-7), Personal Health Questionnaire Depression Scale (PHQ-8), Perceived Stress Scale (PSS-14), and Pittsburgh Sleep Symptom Questionnaire – Insomnia (PSSQ-1). Secondary outcome measures were to acquire participant histories, determine adherence as well as adverse events. Seventy participants (age 21 – 65, mean 40.4 ± 11 years) were enrolled with 24 completing the study in each group. Demographically, the sample consisted of those who identified as white (70%), single (74.3%), and with an education level of high school/G.E.D. or less (77.1%). Intention-to-treat analysis for all outcome measures revealed statistically significant within-groups differences over time for both groups. The study failed to demonstrate statistically between-group differences for these measures. Also, complete case analysis for each week revealed no between-group differences. Additionally, the change from Baseline and Day 28 as determined by a response of an improvement of 50% or higher in scores for each scale revealed no significant strength of association between the groups when considering worst case for the loss to follow-up. Melatonin appeared to be well tolerated with similar adverse events reported as placebo; however, there was a tendency to report more vivid dreams/nightmares as well as next day tiredness/grogginess/sleepiness. Clinical investigations into the use of melatonin as a treatment for depression, anxiety, stress, and sleep difficulties in those recovering from illicit and non-illicit drug dependency are limited and larger studies are warranted. Possible future directions include a study design that is multicenter, the inclusion of a therapy only arm, assessing various doses and timelines, assessing effects in adolescents or females, or limiting inclusion based on prescribed medications, mental health status, medical conditions, prior melatonin use, and/or a specific chemical dependency. Overall, this is the first and largest randomized, double-blind, placebo-controlled, parallel group trial assessing the effects of melatonin upon post-acute withdrawal among males in a residential treatment program. However, the various analyses indicated insufficient evidence to suggest that melatonin and placebo were significantly different, and it may be concluded, based upon the study sample, design, and its limitations, the effect of melatonin on the assessed measures was no different than placebo. Due to the heterogeneity of the participants as evidenced by the participant histories, there exists a possibility of a Type II error that must be considered and not overlooked